Shared Decision Making: Examining Key Elements And Barriers To Adoption Into Routine Clinical Practice

Abstract

For many patients, the time spent meeting with their physician-the clinical encounter-is the most opportune moment for them to become engaged in their own health through the process of shared decision making. In the United States shared decision making is being promoted for its potential to improve the health of populations and individual patients, while also helping control care costs. In this overview we describe the three essential elements of shared decision making: recognizing and acknowledging that a decision is required; knowing and understanding the best available evidence; and incorporating the patient's values and preferences into the decision. To achieve the promise of shared decision making, more physicians need training in the approach, and more practices need to be reorganized around the principles of patient engagement. Additional research is also needed to identify the interventions that are most effective.

Is Shared Decision Making a Utopian Dream or an Achievable Goal?

“…In SDM, patient and doctor relate to and influence each other as they work together to make a decision about the patient's health. SDM takes into account the medical evidence, the doctor's clinical expertise, the patients' values and preferences, and the unique attributes of the patient and his or her family, such as cultural or linguistic affinity and mutual trust [15]. SDM often involves the use of decision aids, which are leaflets or online tools that present the evidence briefly and clearly and help patients clarify their preferences and values regarding the treatment.…”

The American Psychiatric Association Practice Guidelines for the Psychiatric Evaluation of Adults

“…Other barriers relate to the amount of time that the clinician has available to engage in shared decision making or the lack of other resources (e.g., reimbursement, decision aids, other health professional staff) to help support the shared decision-making process (Friedberg et al 2013;Légaré and Witteman 2013;Légaré et al 2008;Sheridan et al 2004). Clinicians may also lack knowledge about how to implement shared decision making, question its utility, or have concerns that it will complicate the therapeutic relationship (Friedberg et al 2013;Légaré and Witteman 2013;Légaré et al 2008;Sheridan et al 2004).…”

“…Clinicians may also lack knowledge about how to implement shared decision making, question its utility, or have concerns that it will complicate the therapeutic relationship (Friedberg et al 2013;Légaré and Witteman 2013;Légaré et al 2008;Sheridan et al 2004). Some clinicians may be accustomed to interacting with patients in a paternalistic or authoritarian manner, which can present a barrier to open communication about patient preferences and values ).…”

A Model of Organizational Context and Shared Decision Making: Application to LGBT Racial and Ethnic Minority Patients

“…Common applications of electronic health records (EHR) that can support shared decision making are patient portals and shared visit notes for patients, 66,67 and clinical decision supports for providers. 68 EHR registries can also support population management (driver 1). Decision aids are often, but not always, delivered via HIT and will be discussed later (driver 4).…”